somebody that I used to know

Everyone has been writing that it was inevitable, but it brings a tinge of sadness nonetheless. Sepia Mutiny is coming to a close.

I've been giving a lot of credit to that blog for putting me in touch with some fascinating folks on the web, but if I really trace it back, all the way back, right to the point of its absolute essence, it wasn't actually Sepia Mutiny. Here's the truth. It was blogs. Yes, that dead dinosaur, this format that I can't seem to quit.

Manish and Anna and Abhi had these amazing, lightning-rod blogs that I and many others read voraciously. I thought Sepia Mutiny was pure brilliance when it started; I thought if you combined such forces, nothing could stop it. Maybe that was partially true. But I saw the price that was paid. Each of their blogs dwindled down. With the exception of Anna, when they did blog, their writing became less personal. And frankly, it was those little moments, the little glimpses inside, those were the things that made me so drawn to the community.

I have always contended that I don't share commonality with people who watch Bollywood movies. It's not idli or samosa or sarees which tied me to anyone. What interested me were their voices, the shared experiences. Things we found funny, that we could only appreciate because of our joint experiences. The way Amardeep could dissect an interesting piece of writing. J-money's sassy commentary on food or television or movies or her parents would remind me of some long-lost friend I never knew I had. Or supplesomething's poetic prose. Or maitri's infallible no-bullsh*t breaking-it-down here's-the-way-it-is observations that would make me want to cheer. The little-sisterly feeling tamasha always brought out in me.

Those were the things which caught my interest, made me want to better know these bloggers. In the beginning, in those early days, right before Sepia Mutiny, these bloggers inadvertently encouraged me to blog. And maybe there are too many, and plentiful, and enough voices now. Maybe we don't need Sepia Mutiny, and maybe we don't need blogs. But me, I'm never making any real connections over Twitter. I'll never find myself endeared to someone by discovering their Facebook page. It's the blogs. It's the words. I'm a sucker for words. I'm a sucker for way, way greater than 140 characters. I'm a sucker for more is more. I won't really miss Sepia Mutiny, because I haven't been reading it for years. But I will miss what Sepia Mutiny promised, and the people who brought us Sepia Mutiny. And I already miss all those voices who've grown quiet.

Me, I'll stay in the ancient times, in this echo chamber, with words, words, words. Manish and Abhi and A N N A taught me how, so blame them.

you gave me a lift

Everything takes perspective, I guess. Like how good a bowl of cereal tastes when you haven't been able to tolerate food for 24 hours.

Or, I had to work a night shift last night. I despise them. Not for the actual work, which is actually rather fun. Nights are creepy and cool in the hospital. You learn by doing what you have to do. Nights always provide the biggest contrast as to how the past several months have shaped me- phone calls that used to fill me with panic and dread are now met with gentle reassurance and a short visit to the bedside to confirm suspicions.

What I despise about night shift is the way it pummels your body and turns your circadian rhythm into the Elaine dance. There's no getting around that one.

But it was only for one night. And also, the morning before I left for night shift, I took a listen to The Shins play Simple Song on SNL. I'd heard the song before, but to be honest, the video that had been released for it had been a bit distracting, so I had not really appreciated it until I saw them perform it live.

It wasn't some powerful and rousing rendition necessarily. But it must be said- if you throw a swell of guitars like this into a song, and the lyrics and vocals are equal to it, consider me a goner. And a line like you feel like an ocean being warmed by the sun and love's such a delicate thing that we do with nothing to prove, which I never knew are fairly hard to beat.

The actual video is kind of goofy and distracted me initially, but I do think it has a bit of a point. It's certainly entertaining enough to watch.

But really, I was just pleased at 3 in the morning to have a little guitar and drumbeat to keep me moving through the hospital. Sometimes all it takes is a simple song.

I've got chills, they're multiplying

I couldn't help myself with the title of the post. It's really the only reason I decided to write today. It's pretty impossible to talk about food poisoning in any kind of entertaining way.

When I was in Peru, SP, AL and I all got a nice, nasty episode of food poisoning right before trekking the Inca Trail. SP was the first to recover, and went out in search of Gatorade powder to keep us from dying during our hike the next day. I had been lying on the bed in misery. But I had also not eaten in over 24 hrs. And there was a roll of delicious Peruvian cookies sitting on the night table.

SP came back to the room to find me guiltily eating the cookies. I paid for it shortly thereafter; I was definitely not ready to be ingesting sugar. She shook her head and asked me what was wrong with me. I have no willpower I guess.

I eyed some cookies this evening, and laughed, thinking of what SP would say. I didn't eat them. My stomach's not quite ready for that, and the muscle aches and chills are settling in, so I am going back to bed, after I force down a little ginger ale. Not the best way to spend my one day off, but at least I wasn't at work when all of this happened- that would have been mortifying.

it was dark and I was over

Today at clinic, a patient found out at the front desk that she didn't have insurance anymore. As a result, she no longer qualifies to come to our clinic. She had just been to the Emergency Department yesterday because she had a UTI and she had not been able to see a resident in clinic quickly enough (although, now that we know that she has lost her insurance, she would not have been seen by a resident anyway). She got antibiotics from the Emergency Department, but she wanted to be seen today because she was still having pain.

Also she has HIV.

Last time she was seen for her HIV, her CD4 count was great, which means her immune system was intact. She was on antiretroviral therapy, and it was working well. All we could do for her today was check her vital signs and make sure she wasn't dying in front of our faces, and tell her that she could go to the Emergency Department if she started to feel worse or developing worrisome symptoms.

If you follow this out to its logical conclusion, you have the dizzying, frustrating, enraging headache that is US healthcare. Patients without insurance do not get seen in the primary care setting. Preventative healthcare falls to the side in these patients, the most vulnerable ones, I might point out. As a result, they get sick and they come to the ER. Sometimes they aren't really sick and they come to the ER. But they come to the ER because they don't have a primary care physician to weigh in one way or another. This patient isn't acutely sick right now, so she probably won't get much out of a visit from the ER today. But thanks to losing her insurance, she won't be able to take her HIV meds, and her CD4 count will most likely plummet, and eventually, she will turn up in the ER with an opportunistic infection, having developed full blown AIDS. Good job, America.

As part of my residency, I rotate through the Emergency Department, and it also turns me into a rage monster, because again, a ton of the patients who turn up don't really need Emergency Services. They do not need a CT of their abdomen, seventeen labs and 12-hrs of monitoring, only to be sent away without explanation by a shrugging, tired ER doctor. They need a primary care physician.

But they're not likely to get one any time soon.

I'd like to complain some more, because there's an entire separate rant about how Internal Medicine programs pay pure lip service to encouraging residents towards primary care, while wholly supporting a system that actively kicks out the desire for anyone to do primary care. But I am tired. And frustrated that I contributed to the problem today because the system tied my hands behind my back.

heartbeats

Today one of my patients asked me how long I'd been a doctor. I get that question frequently in resident clinic, because they know we're all in training. Sometimes I want to answer that I'm not one yet. Other times, I want them to stop giving me a hard time. Today, I just told him how long, which is not very long.

The patient asked, "Do you like it?" I said I did, and that I didn't take it for granted, and that I was lucky to get to do something I love. He nodded fervently and said, "Yeah I used to be a computer repairman, and I used to just jump out of bed every morning, I was so excited to go to work every morning."

I thought that was nice, and a nice surprise.

Towards the end of our conversation, he was sort of starting sentences but not finishing them. I said, "Is there anything else going on?"

He asked defensively, "Like what do you mean?"

I shrugged. "I don't know. You just seemed like you had something more you wanted to tell me."

He then told me he was embarrassed. I thought, here we go, and braced myself for some unnecessarily explicit conversation about sexual dysfunction. As usual, I was wrong. He told me he was embarrassed because he'd been clean for a long time, but this past month, he'd been feeling down, and done cocaine a few times. A tiny little detail that changes the entire appointment- the guy has a mechanical heart valve and an underlying condition that makes him prone to cardiac problems. He absolutely can't be smoking cocaine if he wants to stay alive.

Interesting where conversations take a doctor and a patient behind closed doors.

it feels like years since it's been here

Maybe I have just noticed this because I'm finally on a rotation in which I get to see sunlight (and not just by peeking through patients' rooms while I am rounding, which for the record, I have stooped so low to do), but around here apparently spring has sprung. It seems too early, almost unnatural. There was no real big freeze this year, it seemed, although there probably was- I seem to remember a few days during which I raced from the hospital to my house fearing that I was going to freeze to death.

But all of a sudden, there are blooms everywhere, and the sun is warming everything, and I don't really know why the expression "everything's coming up roses" exists, because it seems to me that it should be daffodils. Roses are delicate and fragrant and fancy and romantic, sure. But daffodils are bright, screaming yellow, and they seem to be the first thing that bursts forward in the spring, announcing warmer days ahead. You don't have to wait around for someone to get you daffodils. In fact, they're best encountered growing out of the ground, a chance meeting as you're walking down the street. Or in my case, when I opened the door this morning, I found that my very own front yard was bursting with a little row of daffodils.

When I was young, and living in Boston, and first learning to really love things, the spring would call to me like the Pied Piper, and I would walk out of my room as if in a trance and wander aimlessly further and further away from home. And on those days, it seemed like quite a heady indulgence, to stop at a florist on Newbury Street and buy fresh daffodils, then carry them home and set them in a blue vase and set them by the window, and stare dreamily out on the Charles River. I am not quite at my leisure to do that anymore, but I get to cast a wistful glance at those daffodils without feeling like I'm splurging.

Which makes me quite happy. Simple things do sometimes.

it's hard to dance with the devil on your back

In my last post, I had posted a link to Gotye's Somebody that I used to know. And it is, indeed, a good and haunting song, and a mesmerizing video.

But.

You know, there's a line in the song that I should probably have heeded more carefully- you can be addicted to a certain kind of sadness.

I'm reminded of advice I frequently give 3rd year medical students (I am of the mind that 3rd year is probably the worst year of medical training, and that includes internship). I always tell them- "when you think you're losing your mind, talking to the other inhabitants of the insane asylum is not likely to be helpful." So I always told them to talk to a 4th year medical student (or better yet, someone not even vaguely connected to medicine).

You can't dig your way out of the dark without looking towards the light. I know Florence + The Machine do not qualify technically as all joy and lightness. But baby steps. And this song, no doubt about it, is a step in the right direction. And it's time for those steps, time to stop running to stand still.

But most importantly, there is still time. Time for every one of us who are still here.

put your records on

Medical training can make you seem bipolar, I suppose. Because you can have a totally in-the-toilet day in which everything goes wrong and patients do poorly and you feel overall horrible about everything, and the very next day, you might be doubled over in laughter about something a patient said (or more likely in reaction to some hilarious story told by a fellow intern, which will only seem hilarious to someone else in the trenches).

I'd imagine that is not healthy, but then, not much of residency is healthy. About the best that can be said about it is that I rarely have much of an opportunity to partake of GG&Ts.

Anyway, now that internship has started to allow me a little time for the mind to wander, I have been listening to a little more music lately. I'm still way behind and sadly probably missing out on a lot of good stuff. But, recently, I heard this song, and every lyric was just the perfect encapsulation of a crappy breakup- not crappy because you didn't want the relationship to end, but just insofar as the manner in which it all went down. I love the lyric I don't even need your love, but you treat me like a stranger and that feels so rough. The video is also pretty awesome. Sigh, sigh, sigh, indeed.

stared at my shoes in the ICU

Today, I did chest compressions on a patient who died.

This man looked like a million bucks yesterday. He was my favorite patient on my service yesterday. He had a pneumonia but he was jovial, he was animated, he was teasing his wife. Overnight, he got transferred to the ICU and just plummeted off the cliff from okay to bleeding from everywhere from an overwhelming infection.

I felt like someone had punched me in the gut. It was the first time I could not really talk to family about a patient's death. I understood, biologically, pathophysiologically, how what happened had happened. I know that things were done appropriately, the right decisions were made, that despite our best efforts, sometimes we can't win. I got all that, logically.

But everything inside of me was twisted up from the suddenness of it all. Internists don't do sudden. We usually have time to prepare and accept and make peace. We usually have relationships with families and patients. We are not trauma surgeons. We don't roll someone into our unit and watch them die before our eyes a day later. Only we did today, and I found myself unequal to the task of reckoning with that. And I will never forget it.

I like to keep my issues strong

Let's not beat around the bush, I was feeling pretty low and pretty sorry for myself. The nadir (which is a term I've picked up since I've grown fond of talking about neutrophils, and now I use in common conversation much to the chagrin of my puzzled buddies, poor things) was right before vacation, and it's funny, because then I didn't talk about it. That's my thing, I guess. When I'm at the lowest of the low, I go on full lockdown and conserve all my thoughts, and try to get by, and I don't talk about how I feel everything giving way underneath me.

It's when I'm trying to scramble back up to normal, to serenity, that's when I start talking about how bad things have been.

Anyway, I was feeling pretty badly about my life and where it's headed and how I live in this horrible bubble, and then AP and I decided, because it's been unseasonably warm for February out here, to go for a drive and take a hike. And let me tell you, when you are met with this sight, you realize maybe there's not so much to complain about:

So things are okay.

Well, not totally. To tell the truth, it was sort of hilarious. AP and I went on this hike about a year ago, and the world was very different at that time, for both of us. Last time, we chatted the whole way, merrily walking along, and came home ready to take on the world. This time, we stopped talking about half way through the hike because we were huffing and puffing so hard we couldn't be bothered to make conversation. It was tragic and funny at the same time. Tragic because internship, that thing that is supposed to turn me into a competent physician able to improve my patients' health, has destroyed my own health.

Oh well, what can you do, but shrug, strap on a bit of bond and realize it's time to struggle back up that hill to well-being, regardless of whether it seems like the task of Sisyphus.

this is your life, this is your time

As the senior resident and I were laughing for the better part of the afternoon, while I still managed to finish my work and get out of the hospital at a reasonably decent hour, I started thinking about the continuum that is internship. It sort of goes like this:

Holy #!@&!, I'm a doctor, and I don't know what I'm doing.

Why is this so hard?

How am I going to do this for three years?!?

Why don't I have better instincts?

How will I ever get any better at this?

Then this weird thing happens. It's just like when you get over someone after pining for them for years. It's just like when you don't particularly like someone, and all of a sudden, you catch a glimpse of them, and you see them in a different light. It's just like when you are totally exhausted from climbing a mountain, but still have to climb down from the mountain- arguably easier, but still exhausting. So then it turns into:

Holy #!@&!, in five months, I'm going to have to help some idiot like me figure out what she's doing!

Why does the senior resident insist on wasting my time?

What the heck is the senior resident doing right now anyway?

How can I be a second year resident if I still haven't done (fill in the blank) yet or learned how to (fill in the blank)?!?

The funny thing about all of that is this should be the sweet spot of internship. I'm of some use to the senior residents, I'm of some use to my patients. I'm even slightly of use to the medical students (though I think I mostly just entertain them at this point).

But there's just this endless push and worry, this push to be better and this worry of falling short. Of course, residency is designed such that falling short is inevitable. That's not much of a consolation, it's more of a frustration.

And my only reaction is to laugh and mumble oh well, oh well, oh well, oh well to myself. I am aware that I am becoming boring, boring, and yet, I madly want to become more boring, dive further, drown completely, immersed.

one step forward, two steps back

Ugh. You guys, I wish I could operate in my personal life the way that I do in my professional life. That sounds ridiculous, I know. But in my professional life, I am logical and calm. I can be generous but I don't allow myself to be pushed around. And I can get extremely upset by a bad outcome, I can work through it, and then I can move on.

But when it comes to getting over things outside of work, I am as hopeless as a penny with a hole in it. I don't understand it.

There's been this running joke, that I'm someone who is to be an internist, which connotes that I am someone who has to analyze a thing to death, look at a thing from every angle, learn its history, follow it until the truth becomes clear. Obsessesive. Relentless. Supposedly.

In contrast, the surgeon is someone who is supposed to cut or cut loose. Black and white. Either there's something to be done and it's done, or there's nothing to be done and it's over. Ruthless. Supposedly.

But the internist is the doctor who tells a patient that maybe it's time to let go and stop fighting so hard when the chances of meaningful recovery are dwindling. And the surgeon is the doctor who will fight the most fiercely and break the hardest sweat if he thinks there is a chance.

At least I spend more time working than anything else right now, so if I'm going to get one part of my life right, it's the right part at the moment.

such a bittersweet symphony

Funny thing about internship is that I feel guilty, somehow, all the time. When I'm at work, I feel like I'm either letting my patients down or the senior resident down, or both. If I get out of work at a reasonable hour, I feel guilty about not reading medical literature or increasing my fund of knowledge. If I have a day off, I feel guilty that I didn't get enough laundry or cleaning done. Or if I have a day off, I feel guilty I am not doing more to enjoy myself. Yep, it is the true height of insanity or depression or some odd mixture of the two- when you come to find that you feel guilty that you are not having enough fun, given the chance.

But on the other hand, I am tired all the time. I just want to sleep. And when I come home, I just want to watch Downton Abbey and chortle at Maggie Smith's one-liners, and maybe if I'm feeling really adventurous, venture into the kitchen. I was inclined tonight, since I actually had a few hours between getting home and collapsing into bed, to make cupcakes.

Even then, I felt they weren't good enough, weren't adequate, and I feel guilty about bringing them to work tomorrow. I might as well own to it- I am firmly of the anti-chocolate cupcake stance. Don't get me wrong- chocolate frosting (especially ganache!), yes indeed. Chocolate chips, absolutely. But chocolate cake... firmly meh. Chocolate cake seems designed for people who don't really care for chocolate. I mean, unless you make flourless chocolate cake, which is basically like eating a chocolate bar, and frankly, that doesn't translate well to cupcake form, and I'm too lazy to figure out how to transport an entire cake into work, and my co-workers can't be bothered to cut into a cake to boot.

But I was tired, and chocolate cupcakes are simple enough to make. The novelty part was the coffee frosting. I've managed to get this far still abhorring coffee, still not drinking it regardless of my extent of sleep-deprivation (long live other forms of caffeination!). I know this makes me an outlier both in the medical field as well as a resident of the greater Northern California area. But there you have it. However, when it comes to baking, I think coffee is a good way to bring out the flavor of chocolate; something about the interplay between the bitter and the sweet seems synergistic. And I also know that interns and residents will ingest coffee in pretty much any form. So that was how I dealt with my daily helping of guilt for the day. We'll see how tomorrow fares.

this is how you remind me of what I really am

This isn't a knock on my ex-bf necessarily (but it kind of is, sorry). A while back, my friend RR told me that you shouldn't get too wrapped up in having the same interests as someone you're interested in dating, that hobbies and pedigrees and professions are not what you should be seeking in common with your significant other. And I still think he's right.

But I do think an exception should be made about certain music choices.

And now that a lot of time has passed and I'm very nearly back to full strength, I can say, slightly tongue-in-cheek, but also meaning every last word of it- I probably should have known things were not going to work out with my ex-bf when he revealed that he really liked Nickelback. That one is going to go in my Parks & Recreations Knope playbook, in which I am going to cheer up some heartbroken friend of mine with: "once I dated a guy who liked Nickelback."

Speaking of Nickelback (Haha! It's hilarious to even speak of Nickelback in my opinion. Okay, but seriously, no offense to Nickelback fans, except, really? You're a Nickelback fan? Isn't fan too passionate a word for a band like Nickelback?), I have to confess that the Lost and Walking Dead recaps on Videogum are one of my favorite time-killers ever. I like them especially because I guiltily watch these horrible shows even though they often drive me bonkers, and the recaps reflect this dichotomy perfectly. And I have to admit that the first time my ex-bf asked me if I liked Nickelback (hahahahaaha, that somehow doesn't get any less funny regardless of how many times I mention it), I immediately thought of those Videogum recaps, because characters are frequently telestrated with "Nickelback lyrics" thought bubbles (for the quintessential example, see here.)

Just a lesson that some misgivings are probably worth heeding. Maybe. Just kidding. Sort of (but not really).

*titling this post almost caused me to drop to the floor

when I'm 64

All week, an elderly gentleman had refused to let his wife go. She was on a breathing machine, she had a bad pneumonia, then her heart failed, so fluid built up in her lungs making breathing more difficult, and then her kidneys failed, making it impossible to remove the fluid from her lungs. This is not a new story. This is a common story of an elderly woman in her 80s who finds herself in the ICU.

I talked to the old man a few days ago, asked him what his wife would have wanted. He would not say, but he did tell me, "I hope she makes it to Valentine's Day." I found that cute but not necessarily a good reason to prolong the woman's life.

Today, I discovered that Valentine's Day was their 60th anniversary. Today, the elderly gentleman listened to his daughters, and agreed to take his beloved wife off the breathing machine. Her husband was so upset that the moment we removed the tube from her throat, he said he did not want to sit there and watch her die. As if she knew that he could not handle very much, she passed away about 10 minutes later without the slightest sign of distress.

It's weird- the amazing things like this which you see in Medicine, and how, regardless of all of these life lessons you see around you, you can't figure out how to apply them to your own life.

Anyway, I spent the rest of the afternoon getting everyone else home to celebrate. The first goal was my fellow intern, who had to run out and buy his wife a present before he got home. Then the other residents who had significant others. Maybe it's good karma or something. Maybe I'm more of a romantic than I think I am. But don't say that out loud, or I'll deny it to the end of my days.

and when I think that I'm alone

Yesterday, the other intern and I were waiting at the grill to get our sandwiches. The guy behind the counter turned around to grab some bread, and somehow revealed a front and center view of premium butt crack. The other intern happened to look over at me and I could see that he had just noticed the same thing I had, and we both burst into hysterics.

It's so dumb, and I can't even tell you why we thought it was so funny. When the med student and the senior resident demanded to know what we were in cahoots about, I mumbled that I'd developed ICU delirium. Maybe I had. It wasn't that funny, but we were in stitches, and I think it was just about release. Things are starting to calm down in intern year, but we still work some pretty hard hours, and in the ICU we see a lot of sad things. So maybe, as a result, we have to laugh at stupid things like someone revealing a bit of their backside.

sooner or later, the fever ends

In the ICU last week, the attending physician, who was a bit of an eccentric, sang the first few bars of Toto's Africa. I was the only one who recognized it. I always forget that I'm frequently surrounded by those much younger than me. The attending pointed at me as if he'd found me out, and accused me, "you're an 80s kid!"

And let it be known that being an 80s kid is quite different than being born in the 80s. No offense to you younger folks.

Being an 80s kid means that you knew Whitney Houston. I'm sorry. I know it's played out, and everyone's got the same story, and there's nothing particularly unique or special about mine. But I think that's exactly the point. That's what all of us were doing. We were all dancing along to I wanna dance with somebody and How will I know in bedrooms and bathrooms and basements. We were all so young and innocent, and her harmless, pure pop songs back then became our soundtrack.

I didn't think until yesterday how weird and dissonant it is to consider now- but Whitney Houston was really a role model for a lot of us when we were young. She had a squeaky clean image, she was a woman of color, standing by herself and holding her own. While her songs were often about teenage complaints (will someone please dance with me or am I going to get stuck sitting on the bleachers? and does this boy like me?!?), they were never desperate, never encouraged girls to be stupid. In her videos, she just seemed overwhelmingly happy. She wasn't necessarily the embodiment of female empowerment in those early videos, but neither was she some doormat. I know it's probably considered some sort of musical sin to be considered safe, and sure, there is something to be said for those other women who pushed the envelope and made people uncomfortable.

But consider this, when comparing to musicians of today. Whitney Houston's songs were not celebrating getting so drunk that you don't know the name of the club you walked into. They were not talking about getting caught in the midst of incriminating acts you didn't remember on a Friday night. They were not talking about brushing your teeth with a bottle of Jack. Sometimes harmlessly catchy is much preferable to dangerously misguided.

Also, Whitney Houston, in her heyday, could sing. No disputing that.

*

I know no one's really reading anymore, but then let's just say I am talking to myself. In an effort to force myself to write a little more, but recognizing that my ability to come up with much of interest is limited, I am going to start dropping very short posts, hopefully on a daily basis. There will probably be a lot of hospital-related stories, and gripes about television shows, in equal measures.

We'll see how it goes, stay tuned.

I don't want to talk about it

So that was horrible, and I am done professionally with both Tom Brady and Madonna. That's all I really want to say about that.

I thought I would bake a lot during my vacation, but I didn't. So many things I thought I would do during vacation, I didn't. I had no concept of how spent I was. Things catch up to you. When I hiked the Inca Trail, the day we reached Macchu Picchu, we were all fine and euphoric. We were tired and wanted a shower, but we didn't feel it all until a few days later when we were waiting to board the plane home.

It took me about three days into vacation to realize that, of the 8 weeks previous, I had spent 5 of them working night shifts (and not consecutively, which would actually have been better). It's not that working nights is so hard. In some ways, the skeleton crew working at nights allows for some more independence and interesting learning that is useful around this time in the year. However, working nights will mess with your body. After a while, I did not know whether it was morning or night. Sunlight meant go to sleep, darkness meant wake up. I was drinking obscene amounts of caffeine. But I didn't really think about it at the time.

Then suddenly, I was sleeping the day away. I was walking around in a fog. I felt submerged. I did not feel like doing anything; actually, I couldn't seem to bring myself to do anything.

In addition to my body needing a long stretch of time to readjust to living, I found, for the first time since I've started internship, I did not want to even think about medicine. I didn't want to have anything to do with it. Usually, I will start to hunger for reading the latest journals. Usually, I am unable to resist the temptation to check on my patients on my computer. Not this time.

I don't view it as some worrisome sign that this is the wrong profession for me or anything so extreme. Residency training, despite all the work hour adjustments and attempts to improve wellness, is still just fundamentally exhausting. There are the hours, which are numerous, but also the work just takes its toll. It sucks you in, at first, envelopes you- you submerge yourself willingly. Until you start to drown.

Luckily, just about then, vacation comes along. So all in all, I am still tired. I sometimes feel disillusioned. I sometimes worry where health care is heading, and where people's attitudes towards their health are heading. I sometimes wonder if I'm learning enough, or if I'll be in a position to teach in a mere six months. It turns out I like this work. It's just that I've now realized that once again, I need to reinvent to allow for a life within this life, if that makes sense.

don't wave no goodbye

The end of the year arrived with little warning. I do not feel like celebrating, though I should. The year has been momentous, in good and bad ways both; it has been an extreme year. So I am ending the year tired, just uncertain of whether the intensity of the past year is something sustainable.

It is tempting to wallow because I am so tired, to breathe a sigh of relief, and be glad this tiresome year is over. But maybe that is what age has taught me, to be a bit more measured. I don't try to keep tally anymore, I do not try to calculate a balance sheet, whether the year was a good one or a bad one. It was another year. It was another year that makes me who I am.

Maybe residency has been the ultimate lesson in realizing that nothing is black and white. There are so many exhausting and terrible things about residency, so many problems with it, and there are maybe just a few truly amazing and magical things about it. But I'm not sorry to be a resident. Which is some tricky math.

If there was another big lesson I learned this past year, it was that you never stop learning new things about yourself, and about others. I really thought I had a lot of things figured out the year before, but I can see now that I still have so much to learn. And that part is not exhausting, not tiring. That part fills me with a sense of wonder.

Anyway, the year is nearly over, and I have been much remiss when it comes to blogging, writing. I hope, now that I've passed the halfway mark of internship, I'll have a bit more of a chance to breathe and reflect. But I know better than to make a bunch of resolutions.

In the meanwhile, here are 11 random things about 2011:

When I broke work hours (>80 hrs/week or >16 hrs in a shift by the new rules), I listened to Helena Beat by Foster the People to keep me going, and it was like rocket fuel.

My 4-year old, adorable godson came to visit and his father taught him to call me Doctor, which is both annoying and comical.

Even though there were probably better movies out there, I really loved Drive and would gladly watch it again, gore and all.

It turns out I sort of like yoga, except that I took it up at the height of allergy season and found the breathing-through-your-nose part really tricky.

Amy Poehler, Melissa McCarthy, Tina Fey, Martha Plimpton and company all bum-rushing the stage for best comedy actress was probably the best thing that has ever happened on an awards show, and definitely the only inspired awards show moment of last year.

I sort of knew things weren't going to work out with S and I when he failed to find Ron Swanson a) the most amazing and b) the most hilarious man on television.

Though it was published much earlier than 2011, I finally picked up The White Tiger by Aravind Adiga after failing miserably at trying to read those stupid Girls with the Whatevers books (I'm sorry, I tried and tried, and I am sure the plot is fascinating but I could not get past the blah prose that did not engage me though I tried time and again to read the books). I don't get to read novels too often, but that was a good place to spend my reading quota, that's for certain. His writing is new and fresh and just what I want to be reading these days.

Months and months later, the FNL series finale's closing moments remain burned in my memory- what a gift it was to have that show for so long. Justified and Terriers were so amazing last year, and sadly only one will be back (but at least that one happens to have Timothy Olyphant on it!). The Walking Dead was infuriating in wasting such initial potential, and The Killing was just infuriating.

The bro-seph officially entered permanent grown-up-ville, and went and got himself married at an over-the-top destination wedding, which was, all told, quite lovely.

Das Racist's Michael Jackson is mesmerizing- how something can seem both so profound and nonsensical at once is modern art at its purest form in my opinion.

I nearly purchased a home this past year, but then realized what I really wanted was space. Now I live in a comfortable (rented) house with a spacious kitchen. Unfortunately, that resulted in a major war with ants at one point last month, but I triumphed. Chocolate ganache, macarons and marshmallows in 2012!

A Happy and Safe New Year's to any of you reading. Since I am working in the ICU these days, a special emphasis on the safe part.

I read again between the lines upon the page

The bro-seph is getting married next week, and I really should be making preparations for that. But frankly, given time off from internship, I've found that instead all I keep doing is tucking myself into a cocoon. It's one of the good and bad thing about my new abode. I love the place, which is great because I am happy when I am at home, but slightly less great because it increases the activation energy required for me to leave the house. I am on the verge of needing an intervention.

It has not helped much that it has been raining, announcing the onset of winter in this neck of the woods, encouraging me to put on warm slippers and drink a glass of red wine. Or that some drama got kicked up in my life just when I was starting to feel even-keeled about things.

Today I've been distracted by other thoughts. Like the very serious question of how it is possible to take two hilarious people, put them in a movie together, and make a wholly un-funny film. I never went to see Due Date when it came out because the trailers did not seem very promising, but it's amazing how humorless it turned out. Galifianakis, who I still enjoy watching when he visits Conan, maybe needs to take a break from all the movies. And I don't even know what to say about RDJ, who if I'm being totally honest with myself hasn't really been charming since Iron Man (not 2). Maybe the movie just revealed the problem with these two actors.

Anyway, you won't believe it, but this actually beats pondering other questions in my life.

Sometimes I wish I was wired a bit differently. I wish I were more casual about things, that I didn't take so much so seriously. I wish my feelings were a bit more transient, a bit more pliable.

But the problem, of course, is that I don't actually wish that. I think what I really wish is that this characteristic occasionally served as a blessing instead of a curse.